Infiltrating carcinoma of the bladder; relation of early diagnosis to five-year survival rate after complete extirpation.

eosinophils. In aged patients who are "doing badly" in general after operation and seem to be "going to pieces," if the cor¬ ticotropin test indicates poor function of the adrenal cortex substitution therapy in the form of administration of "cortisone" (adrenal cortical extract) has sometimes produced striking improvement in the patient's general condition. Therapy must be continued for some days or longer until the patient's general condition is good. At that time the dosage is very gradually cut down over the course of days so that the adrenal cortex will gradually be stimulated to resume functioning. It is very important for the aged patient to get out of bed beginning the day after operation or even the after¬ noon after operation, if possible. This is done no matter what the operation was (unless the patient is in shock), and it is necessary to have plenty of assistance to heip support the patient at first. It has been found that early ambulation helps prevent postoperative complications, such as pneumonia, phlebothrombosis, and emboli. Psychologically these patients are tired and discouraged and need a lot of encouragement. Also, I have found that it does more harm than good to try too hard to change habits or customs of many years standing during the few weeks the patient is in the hospital, no matter how illogical or undesirable they may seem. In conclusion, I would reiterate that the aged often present serious problems when undergoing surgery— urological or otherwise. However, despite these handi¬ caps—with attention to their chronic diseases, nutri¬ tion, and water and electrolyte balance and aided by modern therapy, modern methods of anesthesia, and especially the liberal use of whole blood, the vast major¬ ity of these patients can be brought through major uro¬ logical surgery satisfactorily.